Low priority prescribing survey analysis December 2016

Introduction

The CCGs are making some changes in relation to an area called ‘low priority prescribing’ in line with many other NHS organisations in and nationally.

The CCGs are proposing to stop the funding of certain types of medicines or treatments that are readily available ‘over the counter’ in pharmacies or on the shelves in shops and supermarkets.

The types of medicines and treatments that fall into this category include:

• Treatments for minor ailments, including medicines like paracetamol, ibuprofen, head lice lotion and indigestion tablets.

• Treatments where there is little evidence that they have a real clinical benefit, including cough syrups, nasal congestion sprays, sore throat products and vitamin supplements. Gluten free bread and flour.

In some cases there will still be exceptions to this, such as the prescribing of some of these treatments for people with long term conditions, for babies and children, for breastfeeding mothers or when caring for people at the end of their life.

In order to ensure that the proposals are sound, and the new prescribing policies are appropriate, a survey has been undertaken to capture the views of the local population.

The survey

A total number of 1,400 people completed the online survey (Appendix 1). Hard copies of the survey were provided to participants on request. Not every respondent completed each question. The number of responses received is illustrated next to each question.

Where do respondents live?

Of the 1,400 people completing the survey, a total number of 1,176 people reported where they lived. A breakdown of this is illustrated within Table 1.

People from across Preston, and completed the survey, with the majority of the responders stating that they lived in the Chorley (PR7 and PR 6 localities). A number of responders (224 people) skipped this question. This may be that they were out of area, or didn’t want to divulge this information.

Table 1: Reported locality of responders

Postcode and locality Number of responses PR1 Central Preston and 5.3% (63) PR2 North Preston including Lea, Ashton, Fulwood and Grimsargh 4.51% (53) PR3 North Lancs including Great Eccleston, Pilling, Broughton, Goosnargh and Longridge 1.79% (21) PR4 West Preston including Wesham, Kirkham, Warton, Hesketh Bank, , Tarleton 3.06% (36) PR5 East Preston including , Walton-le-Dale, , , Higher Walton 4.68% (55) PR6 East Chorley area including Brindle, , , White Coppice, 18.79% (221) PR7 West Chorley area including , , Eccleston, , , , Adlington 42.77% (503) PR25 Central Leyland, Farrington, Clayton-le-Woods 10.63% (125) PR26 West Leyland including , , Moss, and Moss Side 2.64% (31)

How old are survey responders?

The age of participants varied from under 18 years to 93 years and is categorised in Table 2. Out of the 1,400 people completing the survey, a total of 1,178 people stated their age. Most of the people responding to the survey were aged over 26 years, with the highest response rates from people aged over 61 years

Table 2: Age of responders

Age of 18 years and below 19-25 years 26-45 years 46-60 years 61+ years responders Number of 41 34 235 373 493 responses

A total number of 1,188 responders stated their gender as illustrated in table 3. Most of the responders stated that they were female.

Table 3: Gender of responders

Male Female 421 767

Survey Responses

A summary of the responses to each of the questions is detailed below.

Question 1 - do you currently pay for prescriptions?

A total of 1,394 people answered this question. Almost 60% of respondents (806 people) stated that they did not pay for their prescriptions compared to 41% (573 people) that said they do pay.

Answered: 1,394 Skipped: 6

Yes

No

Don’t know

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Yes 41.10% 573

No 57.82% 806

Don't know 1.08% 15 Total 1,394

Question 2 - Do you consider yourself to have a disability or long term condition?

A total number of 1,391 people answered this question. Over 50% of responders (808 people) stated that they had a disability or long term condition, compared to 539 who stated that they don’t. Only nine people skipped this question.

Answered: 1,391 Skipped: 9

Yes

No

Prefer not to say

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Yes 58.09% 808

No 38.75% 539

Prefer not to say 3.16% 44 Total 1,391

Question 3 - Are you a carer or someone who has a carer?

A high proportion of people (1,384) completing the survey answered this question. Most responders stated that they were not a carer or someone with a carer (81%). Only 16% of responders stated they were either carers or cared for.

Answered: 1,384 Skipped: 16

Yes

No

Prefer not to say

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Yes 16.18% 224

No 81.29% 1,125

Prefer not to say 2.53% 35 Total 1,384

Question 4 - Are you a parent?

Out of the 1,385 people that responded to this question, almost 70% (966 people) stated that they were a parent.

Answered: 1,385 Skipped: 15

Yes

No

Prefer not to say

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Yes 69.75% 966

No 28.59% 396

Prefer not to say 1.66% 23 Total 1,385

Question 5 - Would you consider yourself to be in the category of either 'maternity', 'pregnancy' or 'breastfeeding mother'?

Almost all responders (96%) stated that they were not in the 'maternity', 'pregnancy' or 'breastfeeding category.

Answered: 1,388 Skipped: 12

Yes

No

Prefer not to say

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Yes 1.44% 20

No 96.18% 1,335

Prefer not to say 2.38% 33 Total 1,388

Question 6 - Do you have coeliac disease?

Under 10% of people responding to the survey stated that they had coeliac disease.

Answered: 1,381 Skipped: 19

Yes

No

Prefer not to say

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Yes 8.18% 113

No 89.21% 1,232

Prefer not to say 2.61% 36

Total 1,381

Question 7 - Please state if you think we should stop prescribing the medicines and treatments in the list below.

Of the 1,334 responses received, most people stated that the prescribing of the medicines and simple treatments listed below should be stopped.

Answered: 1,334 Skipped: 66

Simple pain killers

Pain relief gels, creams and sprays

Antihistamine tablets, capsules and liquids

Nasal sprays for allergies

Vitamins, minerals and health supplements

Toothpastes, mouthwashes and mouth gels

Sore throat and mouth ulcer products

Nasal decongestant sprays, tablets and capsules

Sun protection creams, lotions and sprays

Warts and verruca treatments

Antiperspirants

Cosmetic moisturisers

Cough syrups, linctus and mixtures

Ear wax removers

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Yes No Don't know

Yes No Don't know Total

79.79% 17.36% 2.85% Simple pain killers 1,062 231 38 1,331

65.63% 28.16% 6.21% Pain relief gels, creams and sprays 867 372 82 1,321

59.61% 33.56% 6.83% Antihistamine tables, capsules and liquids 785 442 90 1,317

55.48% 35.63% 8.89% Nasal sprays for allergies 724 465 116 1,305

82.31% 14.29% 3.40% Vitamins, minerals and health supplements 1,089 189 45 1,323

86.97% 9.64% 3.39% Toothpastes, mouthwashes and mouth gels 1,155 128 45 1,328

77.81% 18.47% 3.72% Sore throat and mouth ulcer products 1,024 243 49 1,316

71.03% 23.42% 5.55% Nasal decongestant sprays, tablets and capsules 934 308 73 1,315

89.20% 8.08% 2.72% Sun protection creams, lotions and sprays 1,181 107 36 1,324

67.33% 27.43% 5.24% Warts and verruca treatments 886 361 69 1,316

Antiperspirants 88.59% 7.79% 3.63%

1,172 103 48 1,323

85.90% 9.70% 4.40% Cosmetic moisturisers 1,133 128 58 1,319

81.69% 14.90% 3.40% Cough syrups, linctus and mixtures 1,080 197 45 1,322

Ear wax removers 72.78% 21.23% 5.99%

960 280 79 1,319

Question 8 Do you have any comments about this proposal? (medicines and treatments)

A total of 681 comments have been received. Common themes in favour of stopping the prescribing of these medications and treatments include:

 These are available on the NHS  These are cheaper to buy over the counter  It will save the NHS a lot of money that can be used on other treatments  Anything available over the counter that is cheaper than a prescription should be stopped  Will save GP time (appointments)

Patients told us:

“A great idea” and “the sooner the better” “A sensible idea” “Will help reduce cost to the NHS” “Gob-smacked - I didn’t realise that you (NHS) prescribed all these” “Won’t need a GP appointment”

There was, however, some concern about stopping the prescribing of these products. Common themes include:

 Some people on lower incomes may not be able to afford to buy these over the counter  Elderly people may not be able to afford to pay for these  People with long term conditions or serious allergies should have them on prescription

Comments made by members of the public included:

“Protection must be in place for people on low incomes” “The end of this will affect the most vulnerable” “These should be prescribed for the elderly”

Question 9 - It would help us to understand why you are providing your feedback on this area - which of the below best describes you? (Tick all that apply.)

Most people who responded to the survey described themselves as local residents. Almost a third of responders (351 people) stated they were prescribed one or some of these medications or treatments on the NHS, with almost 20% (247) stating that they knew someone prescribed one or some of these.

Answered: 1,297 Skipped: 103

I am currently prescribed one or some of these treatments on the NHS

Someone I care for is prescribed one or some of these treatments on the NHS

Someone I know is prescribed one or some of these treatments on the NHS

I am a healthcare professional

I am a local resident

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

I am currently prescribed one or some of these treatments on the NHS 27.06% 351

Someone I care for is prescribed one or some of these treatments on the NHS 11.64% 151

Someone I know is prescribed one or some of these treatments on the NHS 19.04% 247

I am a healthcare professional 13.18% 171

I am a local resident 78.64% 1,020

Total Respondents: 1,297

Question 10 - Do you agree with the proposal to stop prescribing gluten free foods (bread and flour) on the NHS in Chorley, South Ribble and Greater Preston?

A total of 1,312 people answered this question. Over half of the responders (56%) stated that the prescribing of gluten free foods should be stopped. From the number of responders who disagreed with the proposal to stop prescribing these products (357), 103 responders stated that they had celiac disease.

Answered: 1,312 Skipped: 88

Yes

No

Don't know

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

Yes 56.10% 736

No 27.21% 357

Don't know 16.69% 219

Total 1,312

Question 11 - Do you have any comments about this proposal? (gluten free foods)

A total of 637 comments were received. Common themes in favour of stopping prescribing gluten free foods include:

 These are available to buy in a supermarket  It will save the NHS a lot of money  Gluten free products are readily available to buy  Find an alternative – bread and wheat based products are not a necessity  It’s a life choice to eat bread/ wheat based products

Comments included

“Amazed that these are prescribed” “everyone pays for their food” “Seems sensible to me” “Gluten free products are widely available” “It is possible to do without bread in a diet”

A small number of respondents who stated that they had coeliac disease supported the proposal, and told us: “I am coeliac and there is a wide variety of gf foods readily available in supermarkets” “Gluten Free food is now readily available from supermarkets” “The NHS cannot fund everything for everybody” Almost all of the people in favour of prescribing gluten free foods stated that they were either prescribed gluten free foods on the NHS, cared for people prescribed with these products, or knew someone who were prescribed these products (see question 12). Common themes opposing the proposal to stop prescribing gluten free products include:

 Coeliac disease is an autoimmune disease, not just a food intolerance  It’s false economy, may provide a short term cost-saving but the knock on effect will have bigger cost implications for the NHS (i.e. referrals to other services)  Cost - gluten free products are more expensive  People with coeliac disease feel that they are being punished - diets will suffer  It’s a way of life for people with coeliac disease  Cost - these foods are expensive to buy from a supermarket  Some people on lower incomes may not be able to afford to buy these products  They should be available for children  Coeliac disease is not a choice and should be supported by the NHS to manage the condition Patients told us:

“Foods provided on prescription are fortified with vitamins and are safe from cross contamination unlike supermarket versions” “I find gluten free products expensive. I feel like a second class citizen”

“We are on low income, a prescription is vital”

Some respondents have suggested prescribing a limited number of gluten free foods to patients that meet certain, agreed criteria.

Question 12 It would help us to understand why you are providing your feedback on this area - which of the below best describes you? (Tick all that apply.)

Most people (1,019) responding to the survey stated that they were local residents. Just over a quarter of responders (329) stated that they were prescribed gluten free products, were a carer for someone, or knew someone that had been prescribed these products.

Answered: 1,245 Skipped: 155

I am currently prescribed gluten free foods on the NHS

Someone I care for is prescribed gluten free foods on the NHS

Someone I know is prescribed gluten free foods on the NHS

I am a healthcare professional

I am a local resident

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Answer Choices Responses

I am currently prescribed gluten free foods on the NHS 7.63% 95

Someone I care for is prescribed gluten free foods on the NHS 2.73% 34

Someone I know is prescribed gluten free foods on the NHS 16.06% 200

I am a healthcare professional 13.17% 164

I am a local resident 81.85% 1,019

Total Respondents: 1,245

Appendix 1 Low priority prescribing survey

Low priority prescribing - Your views...

Introduction

The CCGs in Chorley, South Ribble and Greater Preston (central Lancashire) are making some changes in relation to an area called ‘low priority prescribing’ in line with many other NHS organisations in Lancashire and nationally.

What this means is that they are proposing to stop the funding of certain types of medicines or treatments that are readily available ‘over the counter’ in pharmacies or on the shelves in shops and supermarkets.

The types of medicines and treatments that fall into this category include:  Treatments for minor ailments, including medicines like paracetamol, ibuprofen, head lice lotion and indigestion tablets.  Treatments where there is little evidence that they have a real clinical benefit, including cough syrups, nasal congestion sprays, sore throat products and vitamin supplements. Gluten free bread and flour. In some cases there will still be exceptions to this, such as the prescribing of these treatments for people with long term conditions, for babies and children, for breastfeeding mothers or when caring for people at the end of their life.

Before these changes are made, we would like to gather your views to help us make sure that the proposals are sound and the new prescribing policies are appropriate, and also to inform any other information or interventions we may need to put in place.

The survey will close on Monday 21 November 2016, and a feedback report from the engagement exercise will be published in early December.

If you would like to get in touch with us about this survey or anything else in relation to your local health service, please contact one of the email addresses below: en [email protected] [email protected]

Low priority prescribing - Your views...

Your views...

Low priority prescribing - Your views...

Treatments for minor ailments or treatments with limited clinical benefits

7. Please state if you think we should stop prescribing the medicines and treatments in the list below:

Yes No Don't know

Simple pain killers

Pain relief gels, creams and sprays

Antihistamine tables, capsules and liquids

Nasal sprays for allergies

Vitamins, minerals and health supplements

Toothpastes, mouthwashes and mouth gels

Sore throat and mouth ulcer products

Nasal decongestant sprays, tablets and capsules

Sun protection creams, lotions and sprays

Warts and verruca treatments

Antiperspirants

Cosmetic moisturisers

Cough syrups, linctus and mixtures

Ear wax removers

8. Do you have any comments about this proposal?

9. It would help us to understand why you are providing your feedback on this area - which of the below best describes you? (Tick all that apply.)

I am currently prescribed one or some of these treatments I am a healthcare professional on the NHS I am a local resident Someone I care for is prescribed one or some of these treatments on the NHS

Someone I know is prescribed one or some of these treatments on the NHS

Low priority prescribing - Your views...

Gluten free foods

10. Do you agree with the proposal to stop prescribing gluten free foods (bread and flour) on the NHS in Chorley, South Ribble and Greater Preston?

Yes No Don't know

11. Do you have any comments about this proposal?

12. It would help us to understand why you are providing your feedback on this area - which of the below best describes you? (Tick all that apply.)

I am currently prescribed gluten free foods on the NHS I am a healthcare professional

Someone I care for is prescribed gluten free foods on the I am a local resident NHS

Someone I know is prescribed gluten free foods on the NHS